- Complications Associated With Revision of Sprint Fidelis Leads: Report From the Canadian Heart Rhythm Society Device Advisory Committee
- Contribution of 30 Biomarkers to 10-Year Cardiovascular Risk Estimation in 2 Population Cohorts: The MONICA, Risk, Genetics, Archiving, and Monograph (MORGAM) Biomarker Project
- Reducing Consumption of Sugar-Sweetened Beverages Is Associated With Reduced Blood Pressure: A Prospective Study Among United States Adults
- Endothelial Cell–Derived Endothelin-1 Promotes Cardiac Fibrosis in Diabetic Hearts Through Stimulation of Endothelial-to-Mesenchymal Transition
- Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) Bleeding Score in a Contemporary Spanish Cohort of Patients With Non–ST-Segment Elevation Acute Myocardial Infarction
- Fetal Growth Restriction Results in Remodeled and Less Efficient Hearts in Children
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Complications Associated With Revision of Sprint Fidelis Leads: Report From the Canadian Heart Rhythm Society Device Advisory Committee
It has been observed that implantable cardioverter-defibrillator generator replacement in response to a device advisory may be associated with a substantial rate of complications, including death. We sought to determine the risk of lead revision in response to a lead advisory, which has not been determined previously. Twenty-five implantable cardioverter-defibrillator implantation and follow-up centers from the Canadian Heart Rhythm Society Device Advisory Committee were surveyed to assess complications rates as a result of lead revision due to the Sprint Fidelis advisory issued in October 2007. Complications were encountered in 14.5% of the lead revisions. There were 2 deaths (0.43%). The overall risk of complications (19.8%) was greater among those who underwent lead removal at the time of revision than among those whose leads were abandoned (8.6%; P=0.0008). The risk of complications associated with lead revision due to an advisory is significant. Given the increasing prevalence of lead fracture associated with this advisory (4.97%), however, revision at the time of pulse generator change or other intervention that results in opening of the pocket may be warranted. The present data suggest that lead abandonment at the time of revision may be associated with a lower complication rate. Further data on risk factors for lead fracture will be helpful in advising patients of the risk and benefit in replacing leads affected by an advisory. See p 2384.
Contribution of 30 Biomarkers to 10-Year Cardiovascular Risk Estimation in 2 Population Cohorts: The MONICA, Risk, Genetics, Archiving, and Monograph (MORGAM) Biomarker Project
We examined 30 novel biomarkers representing different pathophysiological pathways in 7915 men and women of the population-based FINRISK97 cohort with 538 incident cardiovascular events at 10 years of follow-up. We then developed a biomarker score from the best biomarkers and validated the score in the 2551 men of the Belfast Prospective Epidemiological Study of Myocardial Infarction (PRIME) cohort with 260 incident cardiovascular events at 10 years of follow-up. The strongest associations with the risk for future cardiovascular events in FINRISK97 were found for N-terminal pro-brain natriuretic peptide, C-reactive protein, brain natriuretic peptide, and sensitive troponin I. In addition to pathophysiological considerations, application of different statistical methods consistently resulted in selection of troponin I, C-reactive protein, and N-terminal pro-brain natriuretic peptide for the establishment of the biomarker score. Adding this score to the conventional risk factor model in Belfast PRIME Men led to additional prognostic information beyond that obtained from the classic risk factors. Furthermore, inclusion of the biomarker score into established risk models significantly reclassified cardiovascular risk estimates by 11% (P=0.0008). This large prospective study in individuals without a history of major cardiovascular disease at baseline showed that the addition of a score consisting of 3 biomarkers to the conventional risk factor model improved the estimation of 10-year risk for serious cardiovascular events. Further validation is needed in other populations, ethnicities, and age groups. See p 2388.
Reducing Consumption of Sugar-Sweetened Beverages Is Associated With Reduced Blood Pressure: A Prospective Study Among United States Adults
Consumption of sugar-sweetened beverages (SSBs) has increased dramatically in the United States. Although high SSB consumption has been linked to excess calorie intake and overweight/obesity, SSBs may have other adverse effects. In a prospective study of 810 US adults with prehypertension and stage I hypertension, we found that reducing SSB consumption was associated with significant reductions in blood pressures (BP). On average, a reduction in SSB intake of 1 serving a day (12 oz/d) was associated with a 1.8-mm Hg reduction in systolic BP and 1.1-mm Hg reduction in diastolic BP over 18 months. A positive association was also found for dietary sugar intake and BP. No association was found for diet beverage consumption or caffeine intake and BP. These findings have important clinical and public health implications. It has been estimated that a 3-mm Hg reduction in systolic BP should reduce stroke mortality by 8% and coronary heart disease mortality by 5%. Such reductions in systolic BP would be anticipated by reducing SSB consumption by an average of 2 servings per day. Currently, the average intake of SSBs is 2.3 servings per day for US adults. Nationwide, 72 million US adults (35%) have hypertension, and another 59 million (29%) have prehypertension. Given the high prevalence of both SSB consumption and hypertension in the United States and throughout much of the world, even small reductions in SSB consumption should have a beneficial public health impact. In conclusion, our data suggest that reducing SSB and sugar consumption may be an important dietary strategy to lower BP. See p 2398.
Endothelial Cell–Derived Endothelin-1 Promotes Cardiac Fibrosis in Diabetic Hearts Through Stimulation of Endothelial-to-Mesenchymal Transition
Despite optimal treatment with current standard therapy, the high risk of heart failure and major cardiovascular events remains an unresolved problem for patients with diabetic cardiomyopathy. Thus, a better understanding of the underlying mechanisms and additional therapeutic strategies is needed. A persistently high plasma endothelin-1 (ET-1) level in diabetic patients is associated with the development of cardiac fibrosis. Considering the unfavorable results from clinical trials using ET-1 receptor blockade in heart failure patients—in contrast to its successful application in pulmonary arterial hypertension patients—we conducted more detailed investigation into the role of specific cell-derived ET-1. The importance of endothelial cells as a major source of ET-1 and the contribution of endothelial dysfunction in the natural history of diabetes cardiovascular complications led us to use endothelial cell–specific ET-1 knockout mice that we generated previously. In a type 1 diabetes model, we made the novel observations that diabetes mellitus–induced cardiac fibrosis is associated with the emergence of fibroblasts from endothelial cells and that this so-called endothelial-to-mesenchymal transition is stimulated by endothelial cell–derived ET-1. This cardiac fibrosis, along with ET-1-induced ultrastructural abnormalities, oxidative stress, and impairment of cardiac microvascularization, contributes to the acceleration of heart failure, which is ameliorated in mice lacking ET-1 in endothelial cells. We therefore suggest that targeting endothelial cell–derived ET-1 might be beneficial in the prevention of diabetic cardiomyopathy. See p 2407.
Evaluating the Performance of the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) Bleeding Score in a Contemporary Spanish Cohort of Patients With Non–ST-Segment Elevation Acute Myocardial Infarction
The current guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction stress the importance of balancing antithrombotic and interventional therapies with therapeutic risk and urge special attention in groups at high bleeding risk, including women and the elderly. However, determining the net benefit of aggressive treatment in this setting can be complicated because of the lack of quantitative tools able to suggest which treatment strategy might be the most appropriate. The Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) score, which involves variables obtained upfront, was found to perform well in the test population. Testing risk scores in a completely independent data set provides a rigorous test of their utility and should be undertaken before its widespread use is recommended. Using data from >700 patients with non–ST-elevation acute myocardial infarction admitted to a single Spanish center, we found that this model performs well for most patients except those treated with >2 antithrombotics who do not undergo cardiac catheterization. The CRUSADE score had excellent capacity in discriminating between high- and low-risk patients (C statistic, 0.82). Moreover, we have established that the CRUSADE risk model maintained its performance even when the study population was stratified by subgroups of age (≥75 versus <75 years) (C statistic, 0.80 and 0.81, respectively). The major bleeding predicted by the model closely approximated that observed in this study. Validation of risk models within the population to which they are to be applied is essential. Only then can physicians and healthcare providers be reassured of the performance of the models and subsequently their applicability for risk stratification. See p 2419.
Fetal Growth Restriction Results in Remodeled and Less Efficient Hearts in Children
The present study provides evidence that fetal growth restriction, a condition that affects 5% to 10% of all newborns, is associated with cardiac remodeling and longitudinal myocardial dysfunction in childhood. This association shows a linear increase with the severity of growth restriction and is independent of gestational age at delivery. From a pathophysiological perspective, the results of the study are relevant because they may help to clarify the long-described epidemiological relationship between fetal growth restriction and increased cardiovascular mortality in adulthood. This may result in new opportunities for monitoring and intervention beginning in early life. The present study identifies several therapeutic targets that might be used in future clinical trials. From a public health perspective, the study is relevant because the importance of early identification and intervention in pediatric risk factors for cardiovascular disease is now well recognized; however, fetal growth restriction is not listed among the cardiovascular risk factors in current consensus guidelines. Public health strategies focused at targeting infants affected by fetal growth restriction would involve thousands of children yearly and could reduce the cardiovascular risk of these children when they reach an elderly age. See p 2427.
- Fetal Growth Restriction Results in Remodeled and Less Efficient Hearts in Children
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